Wednesday 17th of September 2014 08:29:46 AM

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Monday, 15 September 2014 07:01 By Joseph Were
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Big money deals expose political power fights

The scandal over the award of the contract to upgrade the 74km Mukono-Katosi road to an alleged fake company, Eutaw Construction Company Inc., has exposed how corruption can be the handwork of top-level politics. It gives a glimpse of the behind-the-scenes political fights happening today that sometimes leave even President Yoweri Museveni helpless.

When Museveni commissioned the Mukono-Katosi road on July 7, 2014, for instance, he was fully aware of the scandal swirling around it but he was helpless to stop it.  He had several reports on his desk that Eutaw might in fact be a fake company.  The office of the IGG had first complained about it in February 2014.

But Museveni appears to have been aware that recurrent public procurement debacles in State House are a result of intra-NRM political manoeuvres and systemic constraints, and not merely corruption. He knows that even if a public official desired to do good under the current system, they might fail and that politico-structural remedies are required, not purges of individuals or single projects.

Monday, 08 September 2014 06:45 By Prabhjot Singh
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Ensuring that people seek care for other ailments amidst fear of clinicians is a challenge

In Sub-Saharan Africa, any child with a fever should receive immediate medical care to prevent death from malaria or pneumonia. But, as panic about the spread of Ebola grips Liberia – as well as Sierra Leone, Guinea, Nigeria, and Senegal – people there are increasingly associating clinicians and health-care facilities with exposure to the disease. Ensuring that they continue to seek care when they need it requires improvements to frontline clinics and investment in locally hired community health workers (CHWs) to reach the vulnerable in their homes.

To be sure, the shortcomings of Liberia’s health-care system long preceded the Ebola outbreak, with roughly 28% of the country’s four million citizens lacking access to adequate facilities. The 2003 Accra Comprehensive Peace Agreement may have ended years of civil war, but it left the country with only 51 doctors and decimated infrastructure.

With very few qualified health-care professionals, repairing the health-care system demands more than building new hospitals and clinics across Liberia’s densely rain-forested countryside. Fortunately, the government, like others in Sub-Saharan Africa, recognises the need to invest in training CHWs in rural counties to treat diarrhea, pneumonia, and malaria – the three major causes of death in children under five years old.

By definition, CHWs have deep relationships with their communities; including traditional healers, which enables them to help the formal health-care system calibrate its approach. At the same time, mobile technologies facilitate quality control and supervision, while providing CHWs with expert clinical support.

In March, Liberia’s health ministry, in collaboration with United Nations agencies, USAID, local and international NGOs, and private companies, created a comprehensive scale-up plan for the country’s community-health program. But Ebola struck soon after, shifting attention to clinics, quarantines, and reports of cures.

The World Health Organization (WHO) has played a central role in coordinating the international response along with national governments, aid groups like Doctors Without Borders, and the US Centers for Disease Control and Prevention (CDC). With the epidemic still growing, the public-health community is attempting to mount an effective response, using a $100 million funding boost to deploy clinicians, epidemiologists, and other experts.

To put this in context, the Liberian plan unveiled in March estimated that a national CHW network would cost some $20 million annually. To be sure, investments in CHWs should not come at the expense of critical public-health measures to slow the spread of Ebola or support for frontline clinics. But without continued investment in CHWs, whose costs are modest compared to those of traditional health-care systems, it will be difficult for the international community and national governments to stop the spread – and prevent the recurrence – of Ebola and other devastating epidemics.

There are two basic approaches to building a health-care system. One has hospitals at the center and clinics radiating outward; the other is founded on social networks and mobilised by CHWs. If the first is too rigid, diseases and their social context evolve beyond its means. If the second is too flexible, the ability to carry out technically complex work is compromised.

Striking the right balance is particularly challenging in areas where access is limited or trust is lacking. Doing so in the midst of an epidemic is even more complicated, owing to the social dimension of epidemics. In other words, how people respond when a child or family member falls ill is shaped by their friends’ and neighbors’ experiences, the availability of health-care services, and the community’s perception of those services; this response, in turn, determines how and to what degree the disease will spread.

As a CDC expert explained, CHWs are the key to stopping Ebola, because anybody who shows symptoms of the disease becomes a “suspected patient,” all of whose contacts must be followed for another three weeks. “Every day, except Sunday, the workers report their findings to a supervisor.”

One organisation, Last Mile Health, has built a network of 300 CHWs that serves 30,000 patients, providing access to basic clinics even in places like hard-to-reach Konobo, Liberia. The organisation’s hybrid structure is capable of addressing regular challenges, while retaining the flexibility to respond to extraordinary developments.

As the rainy season approaches, threatening to facilitate the emergence of multiple epidemics that will overwhelm the health-care system’s capabilities, the need to mobilise, train, and equip citizens to respond has become even more urgent. This demands a combination of targeted development aid, domestic investment, expert support, and on-the-ground perspectives from Sub-Saharan countries that have successfully scaled up CHW networks.

The same is true for all of the countries with active Ebola cases. Indeed, buttressed by the organisations behind the One Million CHWs campaign, these countries are already working to scale up CHWs. But they need more support, and international agencies and development banks remain too focused on containing the Ebola epidemic to offer the needed backing.

International organisations must recognise that they do not have to choose between supporting traditional health-care investments and emergency-response efforts. Long-term investment in credible health-care systems is the only way to head off future epidemics. Otherwise, Sub-Saharan Africa’s people will forever struggle to overcome avoidable health crises.

Prabhjot Singh, a professor of international and public affairs at Columbia University, is Director of Systems Design at the Earth Institute and Chair of the One Million Community Health Worker Campaign in Sub-Saharan Africa.



Monday, 01 September 2014 07:03 By Kintu Nyago
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Western governments oblivious to the fact that  it’s not only gays who have human rights to protect

The pressure exerted on Uganda, by the US and some European countries, after President Yoweri Museveni signed into law the now defunct Anti-Homosexual  Bill into law,  was not premised, genuinely on their championing the human and democratic rights of our people. Their primary concern was on placating the fury of their influential gay lobbies.

Gays in the US are a major constituency of President Barack Obama’s ruling Democratic Party. And similarly, they have a significant presence in many European left-leaning political parties.  And in the US, its Democratic Party’s leaders Obama, Bill and Hillary Clinton, amongst others, who ideologically support the protecting of gay rights.

The influence of the Gay community in the US and Europe is directly related to their capacity to mobilize politically rather than the size of their numbers. In these countries, homosexuals have a presence in their influential middle classes. For instance in the arts, academia and the professions etc. And hence their effective ability to lobby and contribute in the setting of the political agenda in these countries. And as minorities, they are both committed and passionate about their newly found political clout. Indeed, this explains their ability to effectively target and frustrate Uganda’s international relations, trade and development assistance, in their respective home countries.

Monday, 25 August 2014 06:01 By Peter Nyanzi
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In most developed countries, the fear of costly complaints forces businesses to be creative

When complaints are freely heard, deeply considered and speedily reformed, then is the utmost bound of civil liberty attained that wise men look for.” - John Milton

Some time back, a friend posted on Facebook advising his friends; “Go 24 hours without complaining - not even once, then watch how your life starts changing.”  I thought deeply about that statement and wondered if the Ugandan society does indeed need a makeover by ‘complaining’ less.

I immediately disagreed with my friend.

In many African cultures, children are raised with their heads being pumped with the idea that it is ‘bad manners’ to complain; indeed you are punished for it. Parents, elders, teachers, leaders (the boss) ‘are always right.’ So, you just shut up and suffer silently.

Monday, 18 August 2014 06:00 By Paul Kagame, Uhuru Kenyatta, and Yoweri Museveni
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Today’s leaders know what success will look like for this continent’s citizens and what needs to be done

The dream that the twenty-first century will be the “African Century” is powerful and intoxicating. It is also becoming reality. As African officials gathered in Washington, DC, on August 4-6 for the first US-Africa Leaders Summit, it was worth considering the basis – and the limits – of the continent’s progress.

While conflict and poverty remain serious problems in many African regions, our continent is not only more stable than ever before; it is also experiencing some of the highest economic growth rates anywhere on the planet. Over the past decade, tens of millions of people across Africa have joined the middle class; our cities are expanding rapidly; and our population is the most youthful in the world.

But Africans must not take it for granted that their time has come. Words are cheap, and, despite the continent’s positive momentum, we know that history is littered with squandered dreams – nowhere more so than in Africa.


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